Provider Demographics
NPI:1831298496
Name:HULTHEN-KONCSOL, DAWN A (AUD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:A
Last Name:HULTHEN-KONCSOL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6660
Mailing Address - Country:US
Mailing Address - Phone:704-703-1080
Mailing Address - Fax:
Practice Address - Street 1:8924 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6660
Practice Address - Country:US
Practice Address - Phone:704-703-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1242237600000X
NC7348231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147FJOtherBCBSNC
SC30108535OtherSELECT HEALTH OF SC
NC7412976Medicaid
7061923OtherAENTA
SCSAN090Medicaid
NC197917OtherMEDCOST
6374544OtherCIGNA
SC879959OtherWELLCARE OF SC
NCP01720694OtherRAILROAD MEDICARE
6374544OtherCIGNA